Dementia champions: our experiences and challenges

Dementia champions: our

experiences and challenges

Dr Louise Mellor Foundation year one doctor Dr. Iain Wilkinson, SPR Geriatric Medicine

Mrs. Sasha Wade, Service Improvement Lead Dr. Chooi Lee, Consultant geriatrician

Dementia:

Junior Doctors Championing

Change

Dementia

800, 000

people live with dementia in the UK Access to social services and support

Early

diagnosis

Specialised

care

Poor detection

• Previous audit showed poor cognitive

assessment on admission (21%)

• Patients with cognitive impairment missed

• Missed opportunity for:

– Specialist in-patient management

– Appropriate follow up and referral to community support services

What we did

• Junior doctor dementia champions volunteered • Monthly National Dementia CQUIN audit:

1. Screening question

2. AMTS within 72 hours (brief cognitive assessment) 3. Appropriate investigations performed if indicated 4. Appropriate referral for specialist diagnosis

• Wards bench-marked against each other and informed of monthly progress

Aims

• Identify

• Improve rates of diagnosis

• Improve rates of referral

• Empower junior doctors to

make

sustained

improvements in care for

patients with dementia on

the wards

F

A

I

0% 20% 40% 60% 80% 100%

Sep-12 Oct-12 Nov-12 Dec-12

% of Patients >75 years old admitted to Kingston hospital who were asked the memory screening

question compared to Local CQUIN Target

Hospital Average Local CQUIN target 0% 20% 40% 60% 80% 100%

Sep-12 Oct-12 Nov-12 Dec-12

% of Patients >75 years old admitted to Kingston Hospital who had an AMTS recorded within 72 hours of

admission compared to Local CQUIN Target

0% 20% 40% 60% 80% 100%

Sep-12 Oct-12 Nov-12 Dec-12

% of Specialist referrals for patients with suspected dementia admitted to Kingston Hospital compared to Local

Quality Improvement

• ‘Forget-me-not’ dementia scheme • ‘8 important things about me’

• Carer’s passport

• Carer information leaflets

• Hospital-wide education and training • ‘Top-tips’ for looking after people with

Continuing the good work

– 98% use of screening question – 99% AMTS usage on admission

– 100% referral to specialist services on discharge.

• Continue monthly audit

• Establish the use of the ‘forget-me-not’ scheme on the wards

• Education and recruitment of new champions with the new FY1 doctors start in July

Junior doctors leading change

Conclusions

• Changing dementia

awareness

culture

• Lasting

• Improving quality of care and

The “Forget-Me-Not”

scheme is coming to

At Kingston hospital, we care about people with dementia

Our goals are structured by our 5-point plan: “Making SPACE for good dementia care”

“SPACE”

S

P

-Take the time to get useful information and involve the carers/loved ones

A

C

- relationship-centred and individualised

E

C

are plans

should be

person-centred

and

C

are medically

should be

meticulous

and

C

are and

P

artnership-working

with Carers

Provide information

and support

Prevalence of dementia in patients

aged 75 and over in Kingston hospital

• In total, 48% of patients had dementia or

suspected dementia • 89 out of 184 patients • 54 patients with known

dementia

• 35 patients with suspected or new

A person with dementia hospital may not know…….

Who they are Where they are

Why they are there

A person with dementia in hospital might feel:

confused….frustrated….angry…. upset….embarrassed...distressed… alone…frightened

People with dementia in hospital are more likely to:

People with dementia in hospital are more likely to: Have major complications (falls, malnutrition, delirium, pressure sores, incontinence)

Stay longer

Be re-admitted after discharge

Deteriorate mentally, physically and functionally Be discharged to institutionalised long term care

“Forget-Me-not” Top Tips for Dementia

 Take time, slow down.

Faster is not more efficient when it comes to good dementia care.

 Know the Person.

Fill in and review the patient’s 8 Important Things About Me form.

 Involve the Family/Carers.

They know the individual better than anyone. Use the Carer’s Passport.

 Enhance Communication.

Limit your words, use gestures, and offer choices. Ensure dentures, hearing aids and glasses are in place.

 Interpret Behaviours.

Behaviours often reflect unmet needs. Pain? Needs the toilet? Too noisy? Afraid? Lonely? Bored?

 Go With the Flow.

Be flexible, validate concerns, use alternate approaches, try again later, talk about happy times, and tailor your care to each individual.

 Watch for Signs of Delirium and Depression.

Common co-morbidities with dementia.

 Ask for Help.

“Forget-Me-not” Top Tips

Take time, slow down. Know the Person.

Involve the Family/Carers. Enhance Communication. Interpret Behaviours.

Go With the Flow.

Watch for Signs of Delirium and Depression. Ask for Help.

The “

Forget-Me-Not

”

scheme is coming to

Activist Professionalism

Dr. Iain Wilkinson

Specialist Registrar

Professionalism

• What makes / does not make a professional? • Key components1_:

– Specialised knowledge, – Monopoly of service, – Autonomy for practice, – Code of ethics.

Professionalism and Dementia

assessment

• In many hospitals this assessment is performed by the junior doctors

• Imposed and led in a top down manner

• May lead to a sense of deprofessionalisation by the junior medical doctors…

• little control over the system they work in and • may not encourage their active participation.

The ‘Activist’ Professional

• Activist professional

– Shift of the focus from an individual's actions to those of the

group as a whole2

– Harnesses trust, obligation and solidarity2

– Often work to provide care to a minority or underserved

group2

– The dominant concern is social justice3

• These junior doctors felt that they had championed a

change in the culture of the hospital to give lasting

changes affecting the care of patients with dementia…

2. Sachs, J. “The Activist Professional.” Journal of Educational Change 1, no. 1 (2000): 77-94.

3. Castellan B, Hafferty F. “The Complexities of Medical Prefessionalism.” In Professionalism in Medicine - Critical Perspectives, by Julie Aultman Delese Wear, 3. Springer, 2006.

Conclusions

• It was (is) easier than we thought

– Our message is easy to understand

– Staff are dedicated and passionate about looking after their patients well

– Be prepared with your ‘elevator pitch’

• ‘Ward to Board’

– Dementia champions: executives, non-executives and governors. Go to them than get them to visit

Conclusions

• Modelling good practice • Inspiring shared vision • Challenging the process • Enabling others to act • Encouraging the heart

James Kouzes and Barry Posner

Thank you for listening

Chooi.lee@kingstonhospital.nhs.uk Sasha.wade@kingstonhospital.nhs.uk

Iain.wilkinson@doctors.org.uk